title: Total bilirubin is a useful predictor of persisting common bile duct stone in gallstone pancreatitis.
abstract: Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP. Prospective and retrospective data were available from 200 consecutive patients with gallstone pancreatitis at a public teaching hospital from 2003 through 2007. Charts were examined for persisting CBD stones on ERCP and/or intraoperative cholangiography during laparoscopic cholecystectomy. Patients with cholangitis (n = 18) were excluded. Nineteen of the remaining 182 (10%) patients had CBD stones. Mean hospital Day 2 bilirubin was 3.7 mg/dL for patients with CBD stones versus 1.4 mg/dL for those without (P < 0.0001). Seventeen patients (9%) had total bilirubin 4 or greater on hospital Day 2. Of these, eight (4%) had CBD stones (specificity 94%). Of the 165 patients with total bilirubin less than 4, 11 (7%) had CBD stones (P < 0.0001). In gallstone pancreatitis, a serum total bilirubin level 4 mg/dL or greater on hospital Day 2 predicts persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimizing unnecessary procedures.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, California, USA.
authors.forename: Tony
authors.initials: T
authors.lastname: Chan
authors.forename: Arezou
authors.initials: A
authors.lastname: Yaghoubian
authors.forename: David
authors.initials: D
authors.lastname: Rosing
authors.forename: Edward
authors.initials: E
authors.lastname: Lee
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Lewis
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Stabile
authors.forename: Christian
authors.initials: C
authors.lastname: De Virgilio
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000097:blood* / Q000150:complications* / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin